Anxiety Disorders

Question 1

What does the term neurosis mean?

Answer 1

A functional disorder whereby patients are distressed but do not have hallucinations or delusions. Synonymous with anxiety disorders.

Question 2

In anxiety disorders what does fear lead to?

Answer 2

Arousal and avoidance

Question 3

What is Lang’s three system model?

Answer 3

-> thoughts -> feelings -> behaviour ->

Question 4

When danger is perceived or anticipated the brain activates what?

Answer 4

The autonomic nervous system- sympathetic part (release of adrenaline and noradrenaline) fight, flight or freeze

Question 5

What is the primary (evolutionary) function of anxiety?

Answer 5

To protect - it is a response to danger or threat

Question 6

When does the primary (evolutionary) function of anxiety become a problem?

Answer 6

When the perceived danger does not exist ie responding to an imagined psychological threat.

The brain is unable to distinguish between physical and psychological threat.

Question 7

What effects does anxiety have?

Answer 7

Physiological arousal
Racing thoughts
Inability to concentrate
Cognitive bias - Attentin last focus

Question 8

What is Padesky’s anxiety equation?

Answer 8

Anxiety = estimate of danger/ estimate of coping

Question 9

What are the anxiety disorders?

Answer 9

Panic disorder (with or without agoraphobia)
Social anxiety disorder
Specific phobias 
Health anxiety 
OCD 
Body dysmorphia 
PTSD
Generalised anxiety disorder

Question 10

What is GAD?

Answer 10

Essentially a worry problem.
Specific content of worries changes/ varies
Includes worries about worries (type 2 worries)

Question 11

What low level physical symptoms usually accompany GAD?

Answer 11

Insomnia
Muscle tension
GI problems
Headaches

Question 12

In GAD the belief that worrying is useful is often maintained. True or false?

Answer 12

True e.g it motivates, shows responsibility, prepares for problems

Question 13

What is social anxiety disorder?

Answer 13

The fear of a negative evaluation by others.

Can lead to avoidance of feared situations, use of safety behaviours, anticipatory anxiety, unhelpful post mortems following social encounters

Question 14

What are the obsessions experienced in OCD?

Answer 14

Unwanted recurring distressing intrusive thoughts or images.

Question 15

What are some examples of obsessions seen in OCD?

Answer 15

Being contaminated
Sexual imagery
Doubting
Aggression or horrific impulses

Question 16

Are the intrusive thoughts in OCD ego dystonic or systonic?

Answer 16

Ego dystonic

E.g the thoughts are not pleasant and do not fit in with the person’s moral system or values

Question 17

In OCD, to neutralise the distress caused by intrusions, the patient conducts what..?

Answer 17

Neutralising behaviours (compulsions)

Question 18

Describe specific phobias

Answer 18

A marked fear of specific object or situation e.g dogs, balloons, flying, blood

Marked avoidance of such object or situations

Question 19

Describe panic disorder

Answer 19

A fear of your own physiological and psychological reactions

Bodily changes viewed as signs of impending collapse, insanity or death

Accompanying avoidance of situations that may trigger these reactions is known as agoraphobia

Question 20

What is agoraphobia?

Answer 20

A fear of being in situations where escape might be difficult or that help wouldn’t be available if things go wrong.

May be a fear of open spaces, travelling on public transport, visiting a shopping centre, leaving home

If find themselves in a stressful situation, usually experience symptoms of a panic attack

Question 21

What are the symptoms of a panic attack?

Answer 21

Racing heartbeat
Sweating 
Nausea 
Feeling faint 
SOB
Chest pain
Choking sensation 
Shaky limbs
Numbness or pins and needles 
Dry mouth 
Ringing in ears
GI disturbance 
Feeling or dread or fear of dying 
Feeling like you are not connected to your body

Question 22

How long do most panic attacks last?

Answer 22

5 to 20 minutes

Question 23

What are the main treatments for panic disorder?

Answer 23

CBT and medication - SSRI usually or TCA or pregabalin

Support groups

Question 24

What are the general principles when treating animists with medication?

Answer 24

First line = SSRI
Consider SNRI or TCA
Benzodiazepines used for acute distress, not long term management due to tolerance and dependence
Pregabalin can be used as mono therapy or conjunction to antidepressant
Antipsychotics reserved for acute distress or sometimes to augment antidepressant therapy e.g in OCD
Beta blockers can improve somatic symptoms such as tremor and sweating, but do not impact cognitive anxiety

Question 25

How is OCD treated?

Answer 25

CBT

Clomipramine (TCA) or SSRI